摘要目的:分析沿三叉神经分支走行设计放疗靶区及选择性颈淋巴结照射（ENI）的勾画策略在头颈部腺样囊性癌（ACC）术后调强放疗中的疗效。方法:回顾性分析2016年1月至2022年12月在上海交通大学医学院附属第九人民医院接受根治术后放疗且无远处转移的头颈部ACC患者资料。根据原发灶部位、是否神经侵犯以及病理分型等因素制订头颈部ACC术后放疗靶区及调强放疗计划。应用Kaplan-Meier方法进行生存分析，同时评估该靶区勾画原则下的肿瘤局部控制率及局部区域复发模式。结果:共纳入309例患者。中位随访时间为49个月，5年局部控制率达93.2%，全组5年总生存率、无局部区域复发生存率、无远处转移生存率分别为90.8%、90.6%、66.3%。共23例患者出现局部区域复发，其中仅原发灶复发14例，仅区域淋巴结复发5例，原发灶合并区域淋巴结复发4例。原发灶复发患者中，与三叉神经走行区相关的复发共11例，原发灶及手术区域相关复发7例，局部复发患者中无野外复发。淋巴结复发的9例患者中，既往均未行颈部淋巴结清扫术。结论:头颈部ACC术后患者，采用循三叉神经分支走行设计靶区的预防性照射，取得良好的局部控制。选择性颈部淋巴结照射避免了大范围的颈部淋巴引流区照射，且区域复发率低。

abstractsObjective:To analyze the efficacy of delineating the clinical target volume (CTV) following the trajectory of trigeminal nerve branches and elective neck irradiation (ENI) in postoperative intensity-modulated radiotherapy (IMRT) for adenoid cystic carcinoma of head and neck (ACCHN).Methods:In this study, the data of ACCHN patients without distal metastasis who received postoperative radiotherapy after radical surgery at the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine from January 2016 to December 2022 were retrospectively analyzed. Postoperative radiotherapy target zone and intensity-modulated radiotherapy plan for ACCHN were formulated according to the site of primary focus, whether nerve invasion and pathological staging. Kaplan-Meier method was applied to perform survival analysis, while assessing the tumor local control rate and locoregional recurrence pattern under this target zone outlining principle.Results:A total of 309 ACCHN patients were included. With a median follow-up of 49 months, the 5-year local control rate was 93.2%, the 5-year overall survival rate, locoregional recurrence-free survival rate, and distant metastasis-free survival rate were 90.8%, 90.6%, 66.3%, respectively. Twenty-three patients developed locoregional recurrence, including 14 with primary tumor recurrence alone, 5 with regional lymph node recurrence alone, and 4 with both primary and regional lymph node recurrence. Among the patients with primary tumor recurrence, 11 had recurrence related to the trigeminal nerve branches,and 7 had recurrence in the tumor bed or surgical bed region, with no out-of-field recurrence. Among the 9 patients with lymph node recurrence, none had undergone neck dissection.Conclusions:Delineating the CTV following the trigeminal nerve branches in postoperative radiotherapy for ACCHN achieves excellent local control. Elective neck irradiation avoids irradiation of the entire neck lymphatic drainage area with a low regional recurrence rate.